7/28/2023
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Posted by Provider Relations
Fidelis Care would like to notify our providers of an update to our Applied Behavior Analysis (ABA) Clinical Policy.
Effective October 1, 2023, ABA services are not covered by Fidelis Care when provided in a school setting and the site of service must be identified in connection with a service authorization request.
ABA treatment cannot be requested for services that are otherwise covered under the Individuals with Disabilities Education Act (IDEA) or provided in an educational or school-based setting. If medically necessary, supplemental ABA services can occur in coordination with educational services and plans.
Place of Service Code “03”
Effective October 1, 2023, claims for ABA Services with a place of service of code “03-School” will deny.
For additional information, please reference the following resources: